Get Project Submission Form Illinois Department Of Public Health ... - Idph State Il

This guide provides a detailed overview to assist you in completing the Project Submission Form for the Illinois Department of Public Health. Following these steps will help ensure that your submission is accurate and complete, making the process smoother.

Follow the steps to accurately complete the form.

1. Click ‘Get Form’ button to obtain the Project Submission Form and open it in the editor.
2. Provide facility identifying information including facility name, street address, city, ZIP code, and county in the corresponding fields.
3. Describe the project in detail, including project type by selecting from the options: New, Addition, Alteration, Modernization, or Renovation.
4. Indicate if this is a phased project by selecting ‘Yes’ or ‘No,’ and if applicable, attach an occupancy schedule.
5. Address whether the project includes a designated Alzheimer Special Care Unit by selecting ‘Yes’ or ‘No.’
6. Fill in the licensure category and number of beds for each category that is relevant, indicating present, proposed, and change values.
7. Detail the square footage by indicating any increase or decrease related to the project.
8. Attach a valid Certificate of Need (CON) if required for your project, as submission without one will halt the review process.
9. Provide estimated project costs for each item listed, amending the total as necessary.
10. Calculate and submit the appropriate fee based on the total project cost, according to the specified ranges.
11. Include a functional program narrative that details the purpose and demand of the project, along with staffing patterns and space requirements.
12. Complete the systems program narrative if applicable, describing any special systems related to the project.
13. Fill out the contact information section completely for all relevant parties involved in the project.
14. Provide the necessary local code information and structural details as required.
15. Once all fields are filled, users have the option to save changes, download, print, or share the completed form.

Please ensure all documents are filled out accurately and submit your Project Submission Form online.